Tim Kaine is in Hillary Clinton’s camp — and his party’s — on the big health care issues, with a defining moment in his tenure as governor coming in 2007 after the mass shooting at Virginia Tech. His response to the shooting was a $42 million legislative package to reform the state’s mental health system.

As a U.S. senator who was elected in 2012, he’s backed the Affordable Care Act and has pushed for expanded Medicaid eligibility in his state and others. A Catholic, he’s said he opposes abortion personally but supports a woman’s right to choose for herself.

Kaine did not mark himself as a health care reformer when he was Virginia’s governor, but his 2006-2010 term overlapped the recession when little reform was happening anywhere at state or national levels, said Peter Cunningham, a professor of health behavior and policy at Virginia Commonwealth University.

“He was probably pretty typical of the middle-of-the-road Democratic governors in sort of purple states,” Cunningham said. “When the recession hit, that precluded any other major health reform effort that he might have contemplated.”

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Kaine has occasionally incited controversy, however, as in 2007 when Virginia became the first state to require all girls get the human papillomavirus vaccine, protection against a virus that can cause cervical cancer, before enrolling in high school. In 2009, he backed a bill that banned smoking in bars and restaurants in the tobacco-producing commonwealth.

Mental Health

At 32 fatalities excluding the gunman, the Virginia Tech massacre at the hands of a student with mental illness was the deadliest mass shooting in U.S. history at the time.

Almost exactly one year later, Kaine signed a reform package into law bolstering funding for emergency mental health services, children’s mental health services, increased case managers and doctors and jail diversion projects, according to the Virginia Office of the Attorney General.

“Somebody shouldn’t be imprisoned because we won’t provide funding for community mental health,” Kaine said at a mental health conference in 2008, shortly after the bills were signed, according to the Virginian-Pilot in Norfolk, Va.

The package made it easier for authorities to commit someone having a mental health crisis into treatment involuntarily. They no longer had to prove the patient was in “imminent danger,” instead, the new standard required they show a “substantial likelihood” that the person could cause serious harm to themselves or others.

Together, Kaine and the state’s General Assembly made a down payment on longer-term reforms for the delivery of mental health and behavioral health services in Virginia, Cunningham said.

Opioids

Since his election to the Senate four years ago, Kaine has cosponsored bills to establish an advisory committee to help the FDA approve new opioids, reform guidelines for the Department of Veterans Affairs to prescribe opioids, protect first responders from lawsuits when they administer emergency overdose drugs and create a drug monitoring program for Medicare.

Many of those bills were rolled into CARA — the Comprehensive Addiction and Recovery Act of 2016 signed by President Barack Obama in July — which also bore Kaine’s name as a cosponsor.

Affordable Care Act

Though he wasn’t in office while the ACA was being implemented and debated, Kaine supported Obamacare when he ran for Senate and has since cosponsored bills to improve the law.

Kaine has advocated for Medicaid expansion in Virginia and cosponsored legislation to incentivize expansion in other states as well. Like Clinton, Kaine has proposed adjusting the ACA to include some low-income families that aren’t currently covered, fixing the so-called “family glitch.” This year, he cosponsored a bill to require more businesses to provide benefits under the ACA.

Abortion

Kaine, who worked with Jesuit missionaries in Honduras in 1980, follows the Catholic Church’s stand on abortion. His stance has drawn criticism over the years.

“Personally, I’m opposed to abortion and I’m opposed to the death penalty,” he said on Meet the Press in June.

“The right thing for government is to let women make their own decisions,” he continued.

That was a change from Kaine’s position in 2005, when he supported parental consent laws and bans on “partial birth” abortions, causing the Virginia chapter of NARAL Pro-Choice America to withhold an endorsement in his gubernatorial campaign. As governor, he signed a bill creating “Choose Life” license plates in Virginia, which he said was an issue of free speech.

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